Education

Fellowship Program

Program Structure

The training program in Pediatric Surgery at Yale University and Yale-New Haven Children’s Hospital is an ACGME/RRC-approved 2-year fellowship. The Fellowship is intended for surgeons who have completed a full residency in General Surgery and who wish to pursue a career in Pediatric Surgery.

The Fellowship training program emphasizes graded responsibility as the resident progresses through the 2-year Program, assuming more and more independence with seniority. Every patient, whether electively referred or originating in the Emergency Room or Clinic, has an attending responsible for all aspects of the child's care. Attending supervision of patient care complies strictly with ACGME guidelines for resident supervision.

Pediatric surgical patients, wherever hospitalized within the institution, are the responsibility of the Pediatric Surgery Service. In the critical care environments (NICU and PICU) collaborative working relationships are encouraged. The Pediatric Surgery Fellow is responsible for the daily work on the Service and its administrative organization. He/she is the principal surgical consultative resource to the hospital. This comprehensive assignment includes organization of most conferences and assignment of resident and medical students to the daily list of operations. The Fellow is responsible for overseeing all consultations in the emergency room, wards, and clinics, generally after an initial evaluation by a junior house officer or Advanced Practice Nurse.

Clinical Activity

Outpatient Clinic
All outpatient activities related to the fellowship program occur in the Specialty Clinic space on the 2nd Floor of the Yale-New Haven Children’s Hospital. The Pediatric Surgery Fellow and General Surgery Residents participate in the outpatient clinic. The Fellow is expected to attend one half-day clinic session per week and should track the types of cases seen. Surgery is scheduled by the Fellow/Attending team during these office hours. This allows an opportunity for residents and the Fellow to see patients preoperatively and follow them postoperatively. It also allows attending input and supervision of outpatient activities.

Inpatient Care
All inpatient activities take place either in the operating rooms, emergency department, or within the Hospital. The Pediatric Surgery Fellow is joined by one PGY3 resident and one or two PGY1 residents from the Yale General Surgery Residency Program and by two or three Advanced Practice Nurses as part of the inpatient care team. There are separate pediatric ORs that are staffed by Pediatric Anesthesiologists 7 days/week and 24 hours/day. The exact numbers and types of operations vary from year to year but the Fellow performs approximately 1000 major cases over the course of two years. Exact numbers and case distributions are available on request. The most recent ACGME/RRC program review resulted in full accreditation for four years.

Supervision/Work Rules

The Fellowship Program is in compliance with all guidelines for resident supervision established by the ACGME. The work hours rules are in accord with the guidelines established by ACGME. The Fellow is expected to enter daily work hours so that these may be tracked by the Program Director and by the Institution.

Call, Vacation, Pay, Benefits

There is no mandatory in-house call. The Fellow has an office with a computer and access to on-call sleeping quarters if needed. The Fellow is responsible for alternating on-call responsibilities from home with the PGY3 from the General Surgery Program. The Fellow will be permitted to participate in particularly rare or complex cases even when not formally on-call as long as there is no violation of work-hours rules. The Fellow is responsible for creating the on-call schedule and planning vacation time (four weeks/year) with appropriate communication with the Program Director and other faculty.

Details of the salary and fringe benefits including health, disability, life and malpractice insurance, university spending accounts, etc. change from year to year and may be obtained through the Section of Pediatric Surgery.

Evaluations

Evaluations occur in two formats:
First, competency-based formal evaluation takes place at 6-month intervals. Each full-time faculty member evaluates the Fellow based upon technical, administrative, interpersonal, and teaching skills. Comments are aggregated and discussed between the Fellow and Program Director. This evaluation is complemented by input from members of other services such as radiology, anesthesiology, nursing, neonatology, critical care, and pediatrics. The Fellow also evaluates the Program and faculty at the same intervals. These are discussed with the Fellow and Program director who, in turn, discusses them with the entire faculty. All discussions are considered confidential.

Second, informal evaluation occurs at the weekly conferences where the Fellow has ample opportunity to present topics and discuss his/her approach to patient care. These presentations provide an opportunity for the faculty to evaluate the Fellow’s fund of knowledge and depth of understanding for pediatric surgical topics.

The Fellow is required to take the American Board of Surgery In-Service Examination in Pediatric Surgery (PSITE) annually. The results of this examination will be discussed in detail with the Fellow.

Research

Intellectual curiosity is encouraged in the Fellow and research questions often arise during the Fellowship. The Fellow will be encouraged to pursue any research project he/she desires. Clinical studies are the most practical way to pursue research during fellowship and appropriate mentoring for research will be provided as needed. A quality improvement project will be initiated by the Fellow after discussion with the Section Chief and Program Director and this project will be completed by the end of the 2-year program.

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